a comparative study to assess the effectiveness of ...effectiveness of medicated and non-medicated...

International Journal of Science and Research (IJSR) ISSN: 2319-7064

ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426

Volume 8 Issue 9, September 2019

www.ijsr.net Licensed Under Creative Commons Attribution CC BY

A Comparative Study to Assess the Effectiveness of

Medicated and Non-Medicated Sitz Bath on

Episiotomy Wound Healing among Postnatal

Mothers Admitted in Selected Government

Hospital, Tumkur

Suchismita Pati

Department of Obstetrical and Gyanacological Nursing,Sumantai Wasnik Institute of Nursing

Abstract: Aim of the study: Labour is a wondrous act of nature, and unique to every childbearing woman. The onset of motherhood

presents a unique set of physical, emotional and psychological challenges. The post-partum phase can become even more challenging

when the new mother experiences perineal or genital tract trauma as a result of child birth. Episiotomy is a surgical incision in the

perineum to enlarge the vaginal opening for birth as prophylaxis against soft-tissue-trauma. The focus of this study was to evaluate the

effectiveness of Medicated and non-medicated sitz bath on episiotomy wound healing among postnatal mothers at selected hospital,

Tumkur, Karnataka. Objectives: 1) To assess the episiotomy status before and after the sitz bath. 2) To determine the effects of

medicated and non-medicated sitz bath in episiotomy wound healing. 3) To compare the effectiveness of medicated and non-medicated

sitz bath. 4) To associate the demographic variable with the effectiveness of sitz bath on mothers with episiotomy wound healing.

Methods: Through non-probability convenient sampling technique. Data was collected using structured questionnaire. Major Findings

of the Study: The overall analysis of level of episiotomy wound healing of postnatal mothers showed that majority 64% of medicated and

44% of non-medicated sitz bath group subjects episiotomy wound was not healed on the first day assessment. After implementation of

the medicated and non-medicated sitz bath, on the third day assessment majority 40% of subjects had moderately healed episiotomy

wound and 12% of the subjects wound was healed in Medicated group. Whereas in non-medicated group 64% of the subjects had mildly

healed episiotomy wound and 20% of subjects episiotomy wound was not healed. Interpretation and Conclusion: Findings of the study

show that there was a significant difference in pre test and post test level of episiotomy wound healing of postnatal mothers. From this it

is concluded that the Medicated and non-medicated sitz bath both are effective in improving the episiotomy wound healing and it is also

showed significant difference between post test healing scores of medicated and non-medicated group which reveal that the medicated

sitz bath is more effective than the non-medicated sitz bath. And there was no significant association between level of episiotomy wound

healing of postnatal mothers and selected demographic variables.

1. Introduction

Motherhood is a beautiful process whereby the mother

safely delivers a child. Care must be given to ensure safe

childbirth,Safe motherhood . Midwives have cared for

women during childbirth.. During labour, midwives can

literally play a vital role they will be there throughout the

birth to reassure the parents, administer pain relief,

encourage the mother with her breathing, talk her through

the different stages of labour and eventually deliver the

baby. After the baby has been born, the midwife will

continue to care for the mother and baby.

An episiotomy also known as perineotomy, is surgically

planned incision on the perineum and the posterior vaginal

wall during second stage of labor. The incision, which can

be midline or at an angle from the posterior end of the vulva,

is performed under local anesthetic , and is sutured closed

after delivery. It is one of the most common medical

procedures performed on. Nowadays alternative and

complementary methods such as Aromatherapy using

essential oils are established as an alternative therapy for

episiotomy. It is used increasingly and Lavender oil is

frequently prescribed due to its antiseptic and healing

properties 7. The herb's name comes from the Latin lavare,

which means " to wash " and it was used as an antiseptic in

the hospital as well as home setting .

2. Need for Study

A study conducted to establish the prevalence of perineal

pain, the effects of pain on postnatal recovery in Royal

Women‟s Hospital, Victoria, Australia. Researchers

conducted structured interviews of 215 women in the

postnatal ward of tertiary hospital, within 72 hours of

vaginal birth. Results revealed that 90% of women reported

some perineal pain, with 37% reporting moderate or severe

pain. Over a third of women experienced moderate or severe

perineal pain, particularly when walking(33%) or

sitting(39%), while 45% noted that pain interfered with their

ability to sleep. Women reported moderate or severe

perineal pain when they undertook activities involving

feeding their infant (12%) or caring for their infant(12)

Various intervention are found to reduce episiotomy pain

and enhance healing process, which include administration

of analgesics, cleanliness, applying ice pack , topical

application by dry heat (infra red therapy), sitz bath,

performance of Kegel‟s exercise and perineal care 16

.

A sitz bath involves immersion of the pereneal area/

buttocks in warm water (medicated if ordered) at a

temperature of 105 to 110 degree F for 15 to 20 minutes. It

is used to relive discomfort. .A study conducted on

“Pharmacological and non pharmacological treatment for

relief of perinea pain after vaginal delivery” in Brazil to

Paper ID: ART20201494 10.21275/ART20201494 1728





identify the types of pharmacological and non

pharmacological treatment used during hospitalization, in

the relief of perinea pain after vaginal deliveries. Result

reveals that among 130 patients 98.5% used drugs, and

62.3% of them also used non- drug treatments such as Ice

pack, warm sitz bath and hot compress. Effectiveness of sitz

bath versus infrared lamp therapy in the management of

episiotomy pain and wound healing among postnatal

mothers.

3. Review of Literature

A study was conducted in 60 qualified primiparous women

admitted for labour. They were randomly categorized into

two groups: case group using with Lavender oil and control

that using with hospital protocol. Participant‟s pain and

discomfort were recorded using a Visual Analogue Scale

(VAS) and a Redness, Edema, Ecchymosis, Discharge Scale

(REEDA). Pain was evaluated at 4 h, 12 h and 5 days

following episiotomy. Collected data was analyzed in SPSS

14 using an independent t-test and chi-square. There was a

statistical difference in pain intensity scores between the

after episiotomy and the REEDA score was significantly

lower in the experimental group 5 days after

episiotomy (p = 0.000). They concluded that use

of Lavender oil essence can be effective in reducing perineal

discomfort following episiotomy. It was suggested

that Lavender oil essence may be preferably to the use of

betadine for episiotomy wound care 2 groups after 4 h

(p = 0.002, and 5 days (p = 0.000)

Assumptions

Medicated sitz bath may have good effect on episiotomy

wound healing.

Hypotheses

H1: There will be a significant difference between medicated

and non-medicated sitz bath in episiotomy healing.

H2: There will be significant association between the

episiotomy wound healing and selected demographic

variables.

4. Methodology

Research Approach: An evaluative research approach

wais used for this study

Research Design In the present study the quasi-

experimental design with pre test post test control group

design was adapted

Variables under study: (1) Dependent variable: healing

status of episiotomy wound of postnatal mothers is the

dependent variable. (2) independent variables is

Medicated and non-medicated sitz bath on episiotomy

wound.

Setting: The present study was undertaken in Government

Hospital, Tumkur

Population: In this study, target population consists of all

postnatal mothers at Government Hospital, Tumkur.

Accessible Population: In this study, accessible

population consists of postnatal mothers at Government

Hospital, Tumkur who meet the inclusive criteria.

Sample: In this study the sample consisted postnatal

mothers at Government Hospital, Tumkur.

Sample size: The total sample size of this study is 50

postnatal mothers were assigned 25 each in medicated and

non-medicated sitz bath group.

Sampling technique: In this study, convenient sampling

technique was adopted.

Inclusion Criteria

Primi and multi parous mothers with episiotomy

Exclusion Criteria

Who are not willing to participate in the study

Those who don‟t know kannada or English.

Heavy vaginal bleeding with episiotomy

Post natal mothers with perineal tear

Mothers with cardiac diseases, gestational diabetes and

hypertensive disorders etc.

Tool preparation:

Tool used for the research study was REEDA scale

Development of tool:

Section A: Socio Demographic Data: The socio

demographic data consists of 8 items pertaining to Age,

religion, educational status, gravida status, gestational age,

birth weight, type of episiotomy and length of episiotomy.

Section B: Structured episiotomy wound healing

questionnaire

This part of the tool consists of 5 items on various symptoms

of episiotomy wound healing.

Content validity of protocol: The draft of the protocol

along with the criteria checklist was given to 5 experts of

whom, 4 were in the field of Obstetrics and Gynecological

Nursing, and 1 physician. There was 100% agreement by

experts in the content area. Modifications were made as per

suggestions after discussing with the guide.

Reliability: The reliability of the REEDA scale was

established by using inter-rater method. In order to establish

the reliability, the tool was used on 6 postnatal mothers in

government hospital who fulfilled the inclusion criteria. The

reliability quotient obtained for the tool was 0.98.

Pilot study: The pilot study was conducted in the

Government hospital, Tumkur from 17-03-2018 to 20-03-

2018, to assess the feasibility, practicability and assessment

of measurement.

Data Collection Procedure: Formal written permission was

obtained from concerned authorities before data collection.

The data collection period was one month from 22-03-2018

to 17-04-2018. The subjects were selected and the purpose

of the study was explained to them and confidentiality was

taken from all the postnatal mothers by explaining the

purpose of study.The data was collected in the following

phases. pre-test was conducted for each postnatal mother by

using REEDA scale. post test was conducted on 3rd

day after

administration of the protocol; the same REEDA scale was

used. During the conduction of the study there was no

problem aroused and subjects were co operative to conduct

the study.

Paper ID: ART20201494 10.21275/ART20201494 1729





Plan for Data Analysis:

The data was analyzed by using both descriptive and

inferential statistics based on the objectives and hypotheses

of the study.

Descriptive statistics: Baseline proforma containing sample

characteristics were analyzed by using frequency and

percentage distribution.

Inferential statistics: The effectiveness of medicated or

non-medicated sitz bath episiotomy wound healing was

analyzed by paired „t‟ test. Association between mean pre

test episiotomy wound healing scores with their selected

demographic variables were analyzed by chi-square test.

Scoring technique: The REEDA consisted of 5 items. Each

item will be rated from 0 to 3 depending on the level of

symptom. The maximum score was 15

5. Results

This chapter deals with the analysis and the interpretation of

data obtained from 50 postnatal mothers, Each 25 patients in

medicated sitz bath and Non-medicated sitz bath group with

the help of REEDA scale to assess the episiotomy wound

healing status on first and 3rd

postnatal day. Descriptive and

inferential statistics were used to analyze the data that was

collected.

Section I: Demographic Profile of Postnatal Mothers

Table 1: Distribution of Postnatal mothers by their age

N= 50 (E= 25, C= 25)

Age in years Medicated Sitz Bath

Non-medicated Sitz

Bath

Frequency Percentage Frequency Percentage

a) Less than 20 years 9 36 6 24

b) 21-25 years 11 44 11 44

c) 26-30 years 3 12 5 20

d) Above 31 years 2 8 3 12

Total 25 100 25 100

Table 2: Distribution of Postnatal mothers according to their

Religion N=50 (E=25, C= 25)

Religion

Medicated Sitz Bath Non-medicated Sitz Bath


a) Hindu 17 68 20 80

b) Muslim 4 16 2 8

c) Christian 4 16 3 12

Total 25 100 25 100

Table 3: Distribution of Postnatal mothers according to

Educational Status, N= 50 (E= 25, C= 25)

Educational Status Medicated Sitz Bath

Non-medicated Sitz

Bath


a) Illiterate 3 12 4 16

b) Primary Education 13 52 9 36

c) Secondary

education 4 16 7 28

d) PUC and above 5 20 5 20

Total 25 100 25 100

Table 4: Distribution of Postnatal mothers by their

Gestational Age N= 50 (E= 25, C= 25)

Gestational

Age

Medicated Sitz Bath Non-medicated Sitz Bath


a) Pre term 8 32 5 20

b) Term 8 32 11 44

c) Post term 9 36 9 36

Total 25 100 25 100

Table 5: Distribution of Postnatal mothers according to

Type of episiotomy, N= 50 (E= 25, C= 25)

Type of

episiotomy

Medicated Sitz Bath Non-medicated Sitz

Bath


a) Medio-lateral 14 56 11 44

b) Medial 6 24 8 32

c) Lateral 2 8 2 8

d) J Shape 3 12 4 16

Total 25 100 25 100

Table 6: Distribution of Postnatal mothers on Length of

episiotomy, N=50(E=25, C= 25)

Length of

episiotomy

Medicated Sitz Bath Non-medicated Sitz

Bath


Less than 2 cm 7 28 13 52

2.1-4cm 16 64 8 32

More than 4 cm 2 8 4 16

Total 25 100 25 100

Section–II: Level Of Episiotomy Wound Healing Among

Postnatal Mothers Medicated Sitz Bath And Non-Medicated

Sitz Bath Group.

Table 9: Episiotomy wound healing of postnatal mothers on

pre test, N=50(E=25,C=25)

Episiotomy wound

healing level

Medicated Sitz

Bath

Non-medicated Sitz

Bath

Frequency Percent Frequency Percent

Healed 0 0 0 0

Moderately healed 0 0 0 0

Mildly healed 9 36 14 56

Not healed 16 64 11 44

Total 25 100 25 100

Table 10: Episiotomy wound healing of postnatal mothers

on post testN=50(E=25,C=25)

Episiotomy wound

healing level

Medicated Sitz

Bath

Non-medicated Sitz

Bath

Frequency Percent Frequency Percent

Healed 3 12 0 0

Moderately healed 10 40 4 16

Mildly healed 12 48 16 64

Not healed 0 0 5 20

Total 25 100 25 100

Section III: Comparison of Episiotomy Wound Healing

Scores of Postnatal Mothers

Paper ID: ART20201494 10.21275/ART20201494 1730





Table 12: Comparison of pretest and post test episiotomy wound healing scores among postnatal mothers N= 50 (E= 25, C=

25)

Group First Day/pre test Third day/Post test Mean

difference

t

Value Inference

Mean SD Mean SD

Medicated Sitz bath 10.88 2.386 5.68 3.375 5.2 8.826 S

Non-medicated Sitz bath 10.68 2.466 8 2.55 2.68 4.654 S

Mean Difference 0.2 2.32

t Value 0.562 3.717

Inference NS NS

Section IV: Association of Pre Test Episiotomy Wound Healing Scores of Postnatal Mothers Selected Demographic

Variables

Table 13: Association of pre test episiotomy wound healing scores of postnatal mothers medicated sitz bath group with

selected demographic variables N= 25

Variables Below Median Median and above Chi square Df P value (0.05) Inference

1. Age

a. Less than 20 years 1 8

6.411 3 0.093 NS

b. 21-25 years 5 6

c. 26-30 years 1 2

d. Above 31 years 2 0

2. Religion

a. Hindu 6 11

0.554 2 0.758 NS

b. Muslim 2 2

c. Christian 1 3

3. Educational Status

a. Illiterate 0 3

4.25 3 0.236 NS

b. Primary Education 7 6

c. Secondary education 1 3

d. PUC and above 1 4

4. Gravida status

a. Primi gravida 8 10

1.99 1 0.158 NS b. Multi gravida 1 6

5. Gestational age

a. Pre term 3 5

0.043 2 0.979 NS

b. Term 3 5

c. Post term 3 6

6. Birth Weight

a. Less than 2.5 kg 5 12

1.001 1 0.317 NS b. 2.5-3.5kg 4 4

7. Type of episiotomy

a. Mediolateral 5 9

1.645 3 0.649 NS

b. Medial 3 3

c. Lateral 0 2

d. J Shape 1 2

8. Length of episiotomy

a. Less than 2 cm 1 6

2.02 2 0.364 NS

b. 2.1-4cm 7 9

c. More than 4 cm 1 1

Table 14: Association of pre test episiotomy wound healing scores of postnatal mothers of non-medicated sitz bath group

with selected demographic variables N=25

Variables

Below

Median

Median and

above Chi square Df P value (0.05) Inference

1. Age

a. Less than 20 years 2 4

1.799 3 0.615 NS

b. 21-25 years 4 7

c. 26-30 years 1 4

d. Above 31 years 2 1

2. Religion

a. Hindu 6 14

1.707 2 0.426 NS

b. Muslim 1 1

c. Christian 2 1

3. Educational Status

a. Illiterate 2 2

7.129 3 0.068 NS b. Primary Education 1 8

Paper ID: ART20201494 10.21275/ART20201494 1731





c. Secondary education 5 2

d. PUC and above 1 4

4. Gravida status

a. Primi gravida 5 14

3.222 1 0.073 NS b. Multi gravida 4 2

5. Gestational age

a. Pre term 2 3

0.677 2 0.713 NS

b. Term 3 8

c. Post term 4 5

6. Birth Weight

a. Less than 2.5 kg 0 3

5.076 2 0.079 NS

b. 2.5-3.5kg 8 7

c. More than 3.5 kg 1 6

7. Type of episiotomy

a. Mediolateral 4 7

1.474 3 0.688 NS

b. Medial 3 5

c. Lateral 0 2

d. J Shape 2 2

8. Length of episiotomy

a. Less than 2 cm 9 4

12.981 2 0.002 S

b. 2.1-4cm 0 8

c. More than 4 cm 0 4

Testing of hypothesis

H1: There will be a significant difference between medicated

and non-medicated sitz bath in episiotomy healing.

The total difference in the mean of overall episiotomy

wound healing score was 5.2 and 2.68 in the medicated and

non-medicated groups respectively and the obtained t value

is 8.826 and 4.654 found to be significant at the level of

p<0.01. There is improvement in episiotomy wound healing

status of postnatal mothers in both the groups. Whereas the

independent t test computed between post test scores of

medicated and non-medicated group t value are 3.717 which

shows the significant difference between two groups. Hence

the hypothesis H1 is accepted.

6. Summary

Majority 44% of Medicated and non-medicated group

were aged between 21-25 years.

Majority 68% of Medicated and 80% of the non-

medicated group subjects were Hindus.


medicated group subjects had primary education.


medicated group subjects were primi gravidae, and 28%

of medicated and 24% of non-medicated sitz bath group

subjects were multi gravidae.


medicated group subjects had medio-lateral episiotomy.

Pre test episiotomy wound healing scores found to be

10.88 (72.53%) with standard deviation 2.386 in the

medicated group and 10.68 (71.2%) with standard

deviation 2.466 in the non-medicated group which

indicate the homogeneity of subjects in both the groups.

7. Conclusion

The focus of this study was to assess the effectiveness of

medicated and non-medicated sitz bath on episiotomy

wound healing level of postnatal mothers at Government

Hospital Tumkur. Quasi experimental (pre test post test

control group) design and evaluative approach was used in

the study. The data was collected from 50 samples through

convenient sampling technique. The present study assessed

the effectiveness of medicated and non medicated sitz bath

is effective in episiotomy wound healing and reduction in

pain perception

8. Recommendations

A similar study can be replicated on large sample to

generalize the findings.

A similar study can be conducted in different setting.

A true experimental study can be conducted to assess the

effectiveness of medicated sitz bath for episiotomy

wound healing.

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http://www.birth.com.au/Episiotomy-tearing/What-is-

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Paper ID: ART20201494 10.21275/ART20201494 1732

http://studentmedics.co.uk/author/admin/

http://en.wikipedia.org/wiki/Episiotomy#Indications

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http://www.ncbi.nlm.nih.gov/pubmed/22196577

a comparative study to assess the effectiveness of ...effectiveness of medicated and non-medicated...

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